Provider Demographics
NPI:1033600119
Name:HABER, RUBY SAMANTHA (LAC)
Entity Type:Individual
Prefix:
First Name:RUBY
Middle Name:SAMANTHA
Last Name:HABER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3607 NE 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-2256
Mailing Address - Country:US
Mailing Address - Phone:818-645-7413
Mailing Address - Fax:
Practice Address - Street 1:914 SW 11TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2001
Practice Address - Country:US
Practice Address - Phone:818-645-7413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-23
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC185656171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist